Provider Demographics
NPI:1093818270
Name:GRAHAM COUNTY RC
Entity Type:Organization
Organization Name:GRAHAM COUNTY RC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-428-7968
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85548-0870
Mailing Address - Country:US
Mailing Address - Phone:928-428-7968
Mailing Address - Fax:
Practice Address - Street 1:504 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2727
Practice Address - Country:US
Practice Address - Phone:928-428-7968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services